How many of your customers’ group health plans will renew between now and the end of this year? 25%, 40%, 50% or more? We know that you and your staff will be scrambling to make sure all the required enrollment forms are completed on time, rates are delivered and your customers’ plans are “buttoned up” before the end of the year. As you go through all the steps needed to install a new ACA compliant health plan, don’t forget about the need for a new Summary Plan Description. And don’t forget that all of your customers that are enrolled in a SBAM sponsored plan will get a new Summary Plan Description (SPD) from us for free.
With the Affordable Care Act (ACA), most, if not all, group health plans will be replaced in order to meet certain legal requirements such as providing essential health benefits and following established limits on cost-sharing (like deductibles, copayments, and out-of-pocket maximum amounts). This means that at the time of your customer’s health plan renewal, they will need an updated SPD.
Further, nearly every employer, regardless of their size, is subject to ERISA if they offer an employer-provided group benefit including health, dental, vision, accidental death & dismemberment, disability, or group term life insurance; medical flexible spending account or health reimbursement account; wellness and employee assistance program; or any other benefit for which the employer contributes to the cost. The only exempt employers are churches and government entities. A requirement under ERISA is for companies to distribute a written plan document and SPD to all plan participants – including spouses and COBRA enrollees. Remember, that this also must been done timely to stay in compliance with ERISA.
Many small employers mistakenly think the insurance company or their insurance agent is responsible for providing the Summary Plan Description, or that their insurance contract or Summary of Benefits and Coverage will meet the requirement – but it will not. While the employer (plan sponsor) is the one held accountable when the plan is subject to a DOL audit, this doesn’t mean that the agent is off the hook, your customers will turn to you, their health insurance agent, for help in a DOL audit. Don’t wait for that to happen, be proactive and turn to SBAM for an affordable and trustworthy solution.
SBAM takes care of it for you! Every customer enrolled in an SBAM-sponsored BCBSM and BCN plan receives a FREE customized SPD. All you have to do is ask on behalf of your customer. Please contact Kara Wise at kara.wise@sbam.org for details.